5. evidence based practice Flashcards
3 legs of the stool
what’s the problem with the way research and therapy is conducted today?
there are 2 main problems, there’s one general premise
- research takes a nomothetic approach (lab setting)
- therapy is idiographic
general assumption that since tx works in sample, will work in gen pop
what is evidence based practice?
encompasses empirically supported tx but not equivalent
the 3 legged stool
what are the 3 legs of evidence based practice?
- best evidence from research
- clinical expertise
- patient preferences
3 legs of EBP
what’s the best scientific evidence?
results from experiments and quantitative studies
3 legs of EBP
what is clinical expertise?
3 elements
competence attained by psychologists through education, training, experience, that result in effective tx
* expert panels
* practice groups
* consensus statements
3 legs of EBP
what’s patient preference?
4 elements
- satisfaction
- QUALITY OF LIFE
- tx burden
- qualitative studies
what are the 6 levels of research evidence
it’s a pyramid!
- meta-analyses + systematic reviews
- RCTs
- cohort studies
- case-control studies
- case series, case reports
- editorials, expert opinion
what is efficacy?
performance of an intervention under ideal and controlled circumstances
maximizing internal validity, ruling out confounds
what is effectiveness?
how well the tx works among gen pop
generalizability
leg 1: research evidence
what are the sources of evidence of the first leg?
3
- efficacy
- effectiveness
- basic psychological processes relevant to tx
what are some issues with effectiveness when studying therapies in clinical settings?
there are 5 i can think of
- academic settings are usually sterile
- possible allegiance effect
- administered by people who designed the study
- highly trained therapists with advanced degrees
- voluntary bias: types of people who volunteer to do these experiments aren’t representatitve of gen pop
limits generalizability of findings
what is dissemination research?
research that focuses on tx effectiveness testing in real world settings
what are some considerations that must be taken into account when researching therapy txs?
there are 5 i can think of
- patient diversity
- mode of delivery
- feasibility of delivery irl
- tx costs
- therapeutic relationships
what are the 2 most frequent modes of delivery of therapy?
individual and group
what is the most frequent patient pool in therapy experiments?
WEIRD – white/western, educated, industrialized, rich, democratic
what are some things that are important for clinicians to be able to do to successfully perform tx?
there are 8, but you can name like 6 ig idk
- clinical case conceptualization (gathering info to put pieces together)
- tx planning (important to talk to client about it)
- tx implementation
- interpersonal expertise
- self-reflection
- knowledge + use of research literature
- understanding influence of diversity + culture on tx (how tx affects diff clientele)
- seeking consultation + resources
when planning a tx, what’s the first thing that’s important to do?
start with research evidence
what happens if there’s no research evidence to dictate what to do in a therapy session?
make use of clinical judgement + past experience
some questions when evaluating a tx for each pt
5
- what works for whom
- research can examine patient moderators of tx effects
- do tx generalize to minorities?
- how are comorbidities affected in effectiveness of tx?
- phenotypically similar sx can have diff etiological + maintenance factors
what kinds of social and cultural moderators can affect tx?
sex, gender, race, ethnicity, etc
“phenotypically similar sx can have diff etiological + maintenance factors” cool! what does this mean?
even if 2 people have the same dx or comorbidities, doesn’t mean that dx manifests itself in the same way, even if ongoing factors are the same
2 advantages of evidence based practice
- improve quality + cost effectiveness of tx
- enhance accountability
2 criticisms of evidence based practice
- tx amenable to research more likely to be included (RCTs cheaper and shorter)
- inappropriately restrict access to certain tx (healthcare might only pay x amount)
mechanistic research
3 requirements for clear relationship between guiding theoretical base and tx outcome
- proposed mechanisms of change should be validated in basic research (why will this tx work to get this outcome? what will account for change?)
- proposed mechanisms of change should be related to proposed mechanisms for disorder
- change in proposed mechanisms should relate to change in sx in tx studies
what’s an unvalidated tx?
not yet examined sufficiently in a controlled study – not listed as evidence-based, but doesn’t mean that might not work
insurance might not cover yet
what’s an invalidated tx?
shown not to work
